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Consider fatigue, TSH when diagnosing subclinical hypothyroidism in men
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Symptoms, including fatigue, and the serum thyroid-stimulating hormone level should guide the decision to treat subclinical hypothyroidism among men, according to an analysis presented at the Society for Endocrinology BES 2012 meeting.
Typically, the decision to treat patients with thyroxine who have serum TSH levels less than 10 mIU/L is at the discretion of the clinician, according to researcher Asgar Madathil, MBBS, MRCP, of Newcastle University, United Kingdom. Madathil presented data from the 20-year follow-up of the Whickham Survey.
“We should look at both symptoms and the serum TSH value,” Madathil said in an interview with Endocrine Today. “If a patient (with subclinical hypothyroidism) complains of fatigue, we should take that seriously.”
Madathil and colleagues examined the prevalence of fatigue and functional status in 62 patients with subclinical hypothyroidism — defined as those with a serum TSH of 4.5 mIU/L to 10 mIU/L and normal free thyroxine levels — and 1,367 euthyroid patients who served as controls. They excluded patients with known thyroid disease.
The researchers said fatigue and functional impaired status were higher in patients with subclinical hypothyroidism compared with controls (25.8% vs. 15.4%; P=.028 and 56.5% vs. 43.5%; P=.01, respectively).
The ORs for fatigue in patients with subclinical hypothyroidism vs. euthyroid controls were: 1.83 (95% CI, 1.01-3.32) for the entire cohort; 3.29 (95% CI, 1.31-8.26) for males and 1.33 (95% CI, 0.62-2.89) for females. The ORs for impaired functional status were: 1.99 (95% CI, 1.14-3.48) for the entire cohort; 3.56 (95% CI, 1.41-8.98) for males and 1.36 (95% CI, 0.66-2.79) for females.
“After adjusting for confounding variables, there was a strong association [between subclinical hypothyroidism and fatigue and impaired functional status] in males but not in females,” Madathil said, adding that the possible association between subclinical hypothyroidism and impaired functional status and fatigue in women should not be ruled out.
John Wass, MBBS, MD, FRCP, consultant physician and professor of endocrinology at Churchill Hospital in Oxford, said the study strengthens the argument to consider symptoms, as well as TSH levels, in treatment.
“It needs to be confirmed to ensure the veracity, but it’s interesting,” Wass told Endocrine Today. He said it is puzzling that the association existed among men but not women. “There are people who have thyroid symptoms, but who have TSH values in the normal range.” – by Louise Gagnon
For more information:
- Madathil A. Abstract #OC3.7. Presented at: the Society for Endocrinology BES meeting; March 19-22, 2012; Harrogate, United Kingdom.
Disclosure: Drs. Madathil and Wass have no relevant financial disclosures.